8-Exhibit C Medical Repricing.xlsx

XLSX spreadsheet 6 MB Posted Aug 30, 2025

Attached to: HEALTHCARE BENEFITS
Solicitation number: 26RFP005
Issued by: Maricopa County, Arizona

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File	Type	Posted
7-Exhibit B Experience and Census.xlsx	XLSX spreadsheet	Aug 30, 2025
9-Exhibit D Network Disruption - Medical Dental.xlsx	XLSX spreadsheet	Aug 30, 2025
11-Exhibit F Detailed RX Cost Analysis.xlsx	XLSX spreadsheet	Aug 30, 2025
2-Attachment A - Formal Instructions to Respondents.pdf	PDF	Aug 30, 2025
3-Attachment B - Formal Solicitation General Terms Conditions (1).pdf	PDF	Aug 30, 2025
6-Exhibit A Summary Plan Descriptions.pdf	PDF	Aug 30, 2025
10-Exhibit E RX Disruption.xlsx	XLSX spreadsheet	Aug 30, 2025
4-Attachment C Sample City Services Contract.pdf	PDF	Aug 30, 2025
1-26RFP005 Solicitation.pdf	PDF	Aug 30, 2025
5-Attachment D Business Associate Agreement.pdf	PDF	Aug 30, 2025

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Claim_Extract_External

Line_No	CLAIM_TYPE	PROV_NPI	PROV_TIN	PROV_NAME	PROV_ADDR1	PROV_ADDR2	PROV_CITY	PROV_ST	PROV_ZIP	MEMBER_ZIP	PROV_SPECIALTY	PLACE_OF_SERVICE	MSC	PROC_CD	MODIFIER	REVENUE_CD	CONSIDERED_CHARGE
1	IN		273188239	NEIGHBORHOOD OUTREACH ACCESS TO HEALTH	7301 E 2ND ST # 210		SCOTTSDALE	AZ	85251	85308	Hospital	65	FACILITY OUTPATIENT	96156		0520	$210.00
2	IN		362739571	UNITED HEALTHCARE	605 W CHICAGO RD		COLDWATER	MI	49036	85234	Multi-Specialty Group	22	PROFESSIONAL SERVICES	93005		0730	$0.00
3	IN		362739571	UNITED HEALTHCARE	605 W CHICAGO RD		COLDWATER	MI	49036	85234	Multi-Specialty Group	22	PROFESSIONAL SERVICES	93303		0483	$0.00
4	IN		362739571	UNITED HEALTHCARE	605 W CHICAGO RD		COLDWATER	MI	49036	85234	Multi-Specialty Group	22	PROFESSIONAL SERVICES	93320		0483	$0.00
5	IN		362739571	UNITED HEALTHCARE	605 W CHICAGO RD		COLDWATER	MI	49036	85234	Multi-Specialty Group	22	PROFESSIONAL SERVICES	93325		0483	$0.00
6	IN		362739571	UNITED HEALTHCARE	605 W CHICAGO RD		COLDWATER	MI	49036	85234	Multi-Specialty Group	22	PROFESSIONAL SERVICES	99204		0510	$351.00
7	IN		362739571	UNITED HEALTHCARE	605 W CHICAGO RD		COLDWATER	MI	49036	85234	Multi-Specialty Group	22	PROFESSIONAL SERVICES	99214		0510	$468.00
8	IN		362739571	UNITED HEALTHCARE	605 W CHICAGO RD		COLDWATER	MI	49036	85234	Multi-Specialty Group	22	PROFESSIONAL SERVICES	99215		0510	$312.00
9	IN		474131755	CARONDELET ST MARYS HOSPITAL	1601 W SAINT MARYS RD		TUCSON	AZ	85745	85382	Hospital	22	FACILITY OUTPATIENT			0250	$11.00
10	IN		474131755	CARONDELET ST MARYS HOSPITAL	1601 W SAINT MARYS RD		TUCSON	AZ	85745	85382	Hospital	22	FACILITY OUTPATIENT	70450		0350	$5,092.00
11	IN		474131755	CARONDELET ST MARYS HOSPITAL	1601 W SAINT MARYS RD		TUCSON	AZ	85745	85382	Hospital	22	FACILITY OUTPATIENT	71045		0320	$1,077.00
12	IN		474131755	CARONDELET ST MARYS HOSPITAL	1601 W SAINT MARYS RD		TUCSON	AZ	85745	85382	Hospital	22	FACILITY OUTPATIENT	80053		0300	$1,008.00
13	IN		474131755	CARONDELET ST MARYS HOSPITAL	1601 W SAINT MARYS RD		TUCSON	AZ	85745	85382	Hospital	22	FACILITY OUTPATIENT	81001		0300	$350.00
14	IN		474131755	CARONDELET ST MARYS HOSPITAL	1601 W SAINT MARYS RD		TUCSON	AZ	85745	85382	Hospital	22	FACILITY OUTPATIENT	83735		0300	$332.00
15	IN		474131755	CARONDELET ST MARYS HOSPITAL	1601 W SAINT MARYS RD		TUCSON	AZ	85745	85382	Hospital	22	FACILITY OUTPATIENT	85025		0300	$431.00
16	IN		474131755	CARONDELET ST MARYS HOSPITAL	1601 W SAINT MARYS RD		TUCSON	AZ	85745	85382	Hospital	22	FACILITY OUTPATIENT	85610		0300	$259.00
17	IN		474131755	CARONDELET ST MARYS HOSPITAL	1601 W SAINT MARYS RD		TUCSON	AZ	85745	85382	Hospital	22	FACILITY OUTPATIENT	93005		0730	$1,042.00
18	IN		474131755	CARONDELET ST MARYS HOSPITAL	1601 W SAINT MARYS RD		TUCSON	AZ	85745	85382	Hospital	22	FACILITY OUTPATIENT	99285	25	0450	$4,848.00
19	IN		860422559	PHOENIX CHILDRENS HOSPITAL	6524 W SACK DR		GLENDALE	AZ	85308	85008	Hospital	22	FACILITY OUTPATIENT	99283		0450	$1,856.00
20	IN		860422559	PHOENIX CHILDRENS HOSPITAL	6524 W SACK DR		GLENDALE	AZ	85308	85260	Hospital	21	FACILITY INPATIENT			0730	$862.00
21	IN		860422559	PHOENIX CHILDRENS HOSPITAL	6524 W SACK DR		GLENDALE	AZ	85308	85260	Hospital	21	FACILITY INPATIENT			0942	$1,620.00
22	IN		860527381	AETNA ARIZONA MERCY C	PO BOX 29216		NEW YORK	NY	10087	85008	Other/Unknown	22	FACILITY OUTPATIENT	99213		0510	$130.00
23	IN		860527381	AETNA ARIZONA MERCY C	PO BOX 29216		NEW YORK	NY	10087	85008	Other/Unknown	22	FACILITY OUTPATIENT	99213		0510	$390.00
24	IN		860527381	AETNA ARIZONA MERCY C	PO BOX 29216		NEW YORK	NY	10087	85008	Other/Unknown	22	FACILITY OUTPATIENT	99284		0450	$3,016.00
25	IN		860527381	AETNA ARIZONA MERCY C	PO BOX 29216		NEW YORK	NY	10087	85008	Other/Unknown	22	FACILITY OUTPATIENT	99393	EP	0510	$189.00
26	IN		860527381	AETNA ARIZONA MERCY C	PO BOX 29216		NEW YORK	NY	10087	85304	Other/Unknown	22	FACILITY OUTPATIENT	59025		0920	$0.00
27	IN		860527381	AETNA ARIZONA MERCY C	PO BOX 29216		NEW YORK	NY	10087	85345	Other/Unknown	22	FACILITY OUTPATIENT	99213		0510	$130.00
28	IN		860527381	AETNA ARIZONA MERCY C	PO BOX 29216		NEW YORK	NY	10087	85008	Other/Unknown	22	FACILITY OUTPATIENT	99213		0510	$169.00
29	IN		860527381	AETNA ARIZONA MERCY C	PO BOX 29216		NEW YORK	NY	10087	85008	Other/Unknown	22	FACILITY OUTPATIENT	99392	EP	0510	$180.00
30	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT			0637	$3.00
31	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	36415		0300	$34.00
32	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	76815		0402	$491.00
33	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	80053		0301	$359.00
34	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	81001		0307	$85.00
35	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	83690		0301	$158.00
36	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	85025		0305	$140.00
37	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	85460		0305	$218.00
38	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	86900		0309	$133.00
39	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	86901		0309	$100.00
40	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	87086		0306	$104.00
41	IN		860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	99282		0450	$1,167.00
42	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT			0637	$0.00
43	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	36415		0300	$0.00
44	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	59025		0920	$0.00
45	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	76817		0402	$0.00
46	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	80053		0301	$0.00
47	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	81001		0307	$0.00
48	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	82570		0301	$0.00
49	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	83615		0301	$0.00
50	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	84156		0301	$0.00
51	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	84550		0301	$0.00
52	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	85025		0305	$0.00
53	IN		866004791	ARIZONA HEALTH CRE	PO BOX 678863		DALLAS	TX	75267	85203	Laboratory Services	22	FACILITY OUTPATIENT	99214		0510	$0.00
54	IN		900054201	BANNER DESERT MEDICAL CENTER	1400 S DOBSON RD		MESA	AZ	85202	85120	Hospital	22	FACILITY OUTPATIENT			0250	$5.20
55	IN		900054201	BANNER DESERT MEDICAL CENTER	1400 S DOBSON RD		MESA	AZ	85202	85120	Hospital	22	FACILITY OUTPATIENT	76870		0402	$951.00
56	IN		900054201	BANNER DESERT MEDICAL CENTER	1400 S DOBSON RD		MESA	AZ	85202	85120	Hospital	22	FACILITY OUTPATIENT	81003		0307	$98.00
57	IN		900054201	BANNER DESERT MEDICAL CENTER	1400 S DOBSON RD		MESA	AZ	85202	85120	Hospital	22	FACILITY OUTPATIENT	87491		0306	$250.00
58	IN		900054201	BANNER DESERT MEDICAL CENTER	1400 S DOBSON RD		MESA	AZ	85202	85120	Hospital	22	FACILITY OUTPATIENT	87591		0306	$248.00
59	IN		900054201	BANNER DESERT MEDICAL CENTER	1400 S DOBSON RD		MESA	AZ	85202	85120	Hospital	22	FACILITY OUTPATIENT	93976		0250	$64.00
60	IN		900054201	BANNER DESERT MEDICAL CENTER	1400 S DOBSON RD		MESA	AZ	85202	85120	Hospital	22	FACILITY OUTPATIENT	93976		0921	$1,141.00
61	IN		900054201	BANNER DESERT MEDICAL CENTER	1400 S DOBSON RD		MESA	AZ	85202	85120	Hospital	22	FACILITY OUTPATIENT	99284	25	0450	$1,740.00
62	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0200	$6,753.00
63	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0206	$4,502.00
64	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0250	$833.80
65	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0271	$566.00
66	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0300	$606.00
67	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0301	$6,121.00
68	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0302	$556.00
69	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0305	$616.00
70	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0306	$722.00
71	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0307	$98.00
72	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0324	$569.00
73	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0351	$4,003.00
74	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0352	$5,255.00
75	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0450	$3,731.00
76	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0460	$1,980.00
77	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	21	FACILITY INPATIENT			0730	$663.00
78	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	22	FACILITY OUTPATIENT	71045		0324	$512.00
79	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	22	FACILITY OUTPATIENT	80053		0301	$751.00
80	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	22	FACILITY OUTPATIENT	84484		0301	$441.00
81	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	22	FACILITY OUTPATIENT	85025		0305	$240.00
82	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	22	FACILITY OUTPATIENT	93005		0730	$663.00
83	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	22	FACILITY OUTPATIENT	99284	25	0450	$1,740.00
84	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85122	Hospital	22	FACILITY OUTPATIENT	G0480		0301	$554.00
85	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT			0250	$6.80
86	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT	80053		0301	$751.00
87	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT	81001		0307	$161.00
88	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT	83690		0301	$331.00
89	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT	84703		0301	$333.00
90	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT	85025		0305	$240.00
91	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT	87086		0306	$355.00
92	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT	87636		0306	$96.00
93	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT	93005		0730	$663.00
94	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT	96374		0450	$855.00
95	IN	1003232976	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85225	Hospital	22	FACILITY OUTPATIENT	99284	25	0450	$1,740.00
96	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85050	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64493	59	0490	$4,138.00
97	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85050	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64493	RT	0490	$4,138.00
98	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85050	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64494	59	0490	$4,844.00
99	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85050	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64494	RT	0490	$4,844.00
100	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85255	Outpatient Surgery Services	24	FACILITY OUTPATIENT	62321		0490	$4,018.00
101	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85268	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64510	LT	0490	$2,009.00
102	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85268	Outpatient Surgery Services	24	FACILITY OUTPATIENT	77003	TC	0320	$1,231.00
103	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85308	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64483	59	0490	$2,496.00
104	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85308	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64483	RT	0490	$2,496.00
105	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85308	Outpatient Surgery Services	24	FACILITY OUTPATIENT	G0260	LT	0490	$2,050.00
106	IN	1003332883	821195281	DESERT VISTA SURGICAL CENTER LLC	10117 N 92ND ST # 103		SCOTTSDALE	AZ	85258	85308	Outpatient Surgery Services	24	FACILITY OUTPATIENT	G0260	RT	0490	$2,050.00
107	IN	1013539709	850820003	BSC BILTMORE LLC	2222 E HIGHLAND AVE # 100		PHOENIX	AZ	85016	85206	Outpatient Surgery Services	24	FACILITY OUTPATIENT	29881	RT	0490	$5,453.00
108	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT			0250	$678.54
109	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	80053		0301	$150.00
110	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	82550		0301	$98.00
111	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	85025		0305	$104.00
112	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	86140		0300	$39.00
113	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	87040		0306	$128.00
114	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	87040	59	0306	$128.00
115	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	87070		0306	$107.00
116	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	87070	59	0306	$107.00
117	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	87075		0306	$95.00
118	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	87075	59	0306	$95.00
119	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	87077		0300	$122.00
120	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	87186		0306	$64.00
121	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	87205		0306	$46.00
122	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	87205	59	0306	$46.00
123	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	96374		0260	$1,525.00
124	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	96375		0260	$480.00
125	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	J0696		0636	$361.02
126	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	J0878		0636	$920.95
127	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT			0250	$4.95
128	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	71046		0324	$238.00
129	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	73560	LT	0320	$198.00
130	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	96374		0450	$305.00
131	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	96375		0450	$120.00
132	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	99284	25	0450	$1,220.00
133	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	J1885		0636	$83.42
134	IN	1023032588	810231793	ST PATRICK HOSPITAL	500 W BROADWAY ST		MISSOULA	MT	59802	59801	Hospital	22	FACILITY OUTPATIENT	J3010		0636	$56.95
135	IN	1023092053	020222140	MARY HITCHCOCK MEMORIAL HOSPITAL	1 COURT ST		LEBANON	NH	03766	85252	Hospital	22	FACILITY OUTPATIENT	70486		0351	$2,700.00
136	IN	1033107743	160960470	CROUSE HEALTH HOSPITAL INC	2775 ERIE BLVD E		SYRACUSE	NY	13224	85284	Hospital	22	FACILITY OUTPATIENT	71046	TC	0320	$244.00
137	IN	1033107743	160960470	CROUSE HEALTH HOSPITAL INC	2775 ERIE BLVD E		SYRACUSE	NY	13224	85284	Hospital	22	FACILITY OUTPATIENT	80048		0301	$21.00
138	IN	1033107743	160960470	CROUSE HEALTH HOSPITAL INC	2775 ERIE BLVD E		SYRACUSE	NY	13224	85284	Hospital	22	FACILITY OUTPATIENT	80076		0301	$41.00
139	IN	1033107743	160960470	CROUSE HEALTH HOSPITAL INC	2775 ERIE BLVD E		SYRACUSE	NY	13224	85284	Hospital	22	FACILITY OUTPATIENT	81003		0307	$17.00
140	IN	1033107743	160960470	CROUSE HEALTH HOSPITAL INC	2775 ERIE BLVD E		SYRACUSE	NY	13224	85284	Hospital	22	FACILITY OUTPATIENT	83735		0301	$62.00
141	IN	1033107743	160960470	CROUSE HEALTH HOSPITAL INC	2775 ERIE BLVD E		SYRACUSE	NY	13224	85284	Hospital	22	FACILITY OUTPATIENT	84702		0301	$114.00
142	IN	1033107743	160960470	CROUSE HEALTH HOSPITAL INC	2775 ERIE BLVD E		SYRACUSE	NY	13224	85284	Hospital	22	FACILITY OUTPATIENT	85025		0305	$21.00
143	IN	1033107743	160960470	CROUSE HEALTH HOSPITAL INC	2775 ERIE BLVD E		SYRACUSE	NY	13224	85284	Hospital	22	FACILITY OUTPATIENT	86308		0300	$17.00
144	IN	1033107743	160960470	CROUSE HEALTH HOSPITAL INC	2775 ERIE BLVD E		SYRACUSE	NY	13224	85284	Hospital	22	FACILITY OUTPATIENT	87637		0309	$240.00
145	IN	1033107743	160960470	CROUSE HEALTH HOSPITAL INC	2775 ERIE BLVD E		SYRACUSE	NY	13224	85284	Hospital	22	FACILITY OUTPATIENT	99284	25	0450	$1,046.00
146	IN	1033153994	205706445	ARROWHEAD ENDOSCOPY CENTER	7168 W CAMPO BELLO DR # A		GLENDALE	AZ	85308	85086	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378	33	0490	$1,240.00
147	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85032	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64483	LT	0490	$6,430.50
148	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85032	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64484	LT	0490	$1,071.75
149	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85203	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64483	LT	0490	$2,143.50
150	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85203	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64484	LT	0490	$1,071.75
151	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85203	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64635	LT	0490	$3,331.20
152	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85203	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64636	LT	0490	$1,665.60
153	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85302	Outpatient Surgery Services	24	FACILITY OUTPATIENT	62321		0490	$2,143.50
154	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85302	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64490	LT	0490	$1,714.80
155	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85302	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64490	RT	0490	$1,714.80
156	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85302	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64491	LT	0490	$857.40
280	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	21	FACILITY INPATIENT			0710	$1,080.00
281	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	21	FACILITY INPATIENT			0920	$866.00
282	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT			0637	$3.00
283	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	36415		0300	$136.00
284	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	59025		0920	$1,732.00
285	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	76815		0402	$982.00
286	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	76817		0402	$894.00
287	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	80053		0301	$1,077.00
288	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	81001		0307	$255.00
289	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	81003		0307	$40.00
290	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	82570		0301	$68.00
291	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	83036		0301	$92.00
292	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	83615		0301	$342.00
293	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	84156		0301	$372.00
294	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	84443		0301	$165.00
295	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	84550		0301	$312.00
296	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	85025		0305	$560.00
297	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	86803		0302	$165.00
298	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	87389		0306	$153.00
299	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	99213		0510	$120.00
300	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85203	Hospital	22	FACILITY OUTPATIENT	99214		0510	$270.00
301	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85297	Hospital	22	FACILITY OUTPATIENT			0250	$153.51
302	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85297	Hospital	22	FACILITY OUTPATIENT			0272	$274.00
303	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85297	Hospital	22	FACILITY OUTPATIENT	16020		0361	$1,205.00
304	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85297	Hospital	22	FACILITY OUTPATIENT	16020		0450	$1,205.00
305	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85297	Hospital	22	FACILITY OUTPATIENT	97110	59	0430	$359.00
306	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85297	Hospital	22	FACILITY OUTPATIENT	97140	GO	0430	$874.00
307	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85297	Hospital	22	FACILITY OUTPATIENT	97165	GO	0434	$1,060.00
308	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85297	Hospital	22	FACILITY OUTPATIENT	97760	GO	0430	$222.00
309	IN	1073576740	860830701	VALLEYWISE HEALTH	33 W TAMARISK ST		PHOENIX	AZ	85041	85297	Hospital	22	FACILITY OUTPATIENT	99283		0450	$1,933.00
310	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85050	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378		0490	$771.00
311	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85250	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239	51	0490	$808.00
312	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85250	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	33	0490	$1,012.00
313	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85251	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	59	0490	$1,012.00
314	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85251	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
315	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85257	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	33	0490	$1,012.00
316	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85020	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380		0490	$1,012.00
317	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85023	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
318	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85028	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378		0490	$771.00
319	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85032	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378	33	0490	$771.00
320	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85050	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239	51	0490	$808.00
321	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85050	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378	33	0490	$771.00
322	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85050	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	33	0490	$1,012.00
323	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85086	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
324	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85213	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378	33	0490	$771.00
325	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85250	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380		0490	$1,012.00
326	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85251	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239	51	0490	$808.00
327	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85251	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45331		0490	$771.00
328	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85251	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378		0490	$771.00
329	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85251	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	33	0490	$1,012.00
330	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85254	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239		0490	$808.00
331	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85255	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378	33	0490	$771.00
332	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85255	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380		0490	$1,012.00
333	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85255	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	33	0490	$1,012.00
334	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85255	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	59	0490	$1,012.00
335	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85255	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
336	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85257	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239		0490	$808.00
337	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85257	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239	51	0490	$808.00
338	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85257	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	33	0490	$1,012.00
339	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85257	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	59	0490	$1,012.00
340	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85257	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
341	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85257	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
342	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85258	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385		0490	$1,012.00
343	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85258	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
344	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85259	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	33	0490	$1,012.00
345	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85260	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239	51	0490	$808.00
346	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85260	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	59	0490	$1,012.00
347	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85260	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385		0490	$1,012.00
348	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85260	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
349	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85262	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378	33	0490	$771.00
350	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85268	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380		0490	$1,012.00
351	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85268	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	59	0490	$1,012.00
352	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85268	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
353	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85298	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239	51	0490	$808.00
354	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85298	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380		0490	$1,012.00
355	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85331	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378	33	0490	$771.00
356	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85331	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380		0490	$1,012.00
357	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85331	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	33	0490	$1,012.00
358	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85377	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378	33	0490	$771.00
359	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85392	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378	33	0490	$771.00
360	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85249	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378		0490	$771.00
361	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85255	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	59	0490	$1,012.00
362	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85255	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
363	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85257	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239	51	0490	$808.00
364	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85257	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
365	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85259	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	33	0490	$1,012.00
366	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85024	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	59	0490	$1,012.00
367	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85024	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$1,012.00
368	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85331	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378		0490	$771.00
369	IN	1073588356	201456252	DHS ARIZONA ENDOSCOPY CENTER	8573 E PRINCESS DR # 117B		SCOTTSDALE	AZ	85255	85251	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239		0490	$808.00
370	IN	1073845087	271798256	EYE SURGERY CENTER AT THE BILTMORE	2222 E HIGHLAND AVE # 101		PHOENIX	AZ	85016	85254	Outpatient Surgery Services	24	FACILITY OUTPATIENT	68110	LT	0490	$1,036.00
157	IN	1033250618	261184708	MCDOWELL AMBULATORY SURGERY CENTER LLC	1301 E MCDOWELL RD # 100		PHOENIX	AZ	85006	85302	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64492	LT	0490	$857.40
158	IN	1033400619	272944317	SANTAN SURGERY LLC	1704 E BOSTON ST		GILBERT	AZ	85295	85286	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64635	LT	0490	$2,000.00
159	IN	1033400619	272944317	SANTAN SURGERY LLC	1704 E BOSTON ST		GILBERT	AZ	85295	85296	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64490	LT	0490	$2,000.00
160	IN	1033400619	272944317	SANTAN SURGERY LLC	1704 E BOSTON ST		GILBERT	AZ	85295	85296	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64490	RT	0490	$2,000.00
161	IN	1033400619	272944317	SANTAN SURGERY LLC	1704 E BOSTON ST		GILBERT	AZ	85295	85296	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64633	RT	0490	$2,000.00
162	IN	1033400619	272944317	SANTAN SURGERY LLC	1704 E BOSTON ST		GILBERT	AZ	85295	85296	Outpatient Surgery Services	24	FACILITY OUTPATIENT	G0260	51	0490	$2,000.00
163	IN	1033400619	272944317	SANTAN SURGERY LLC	1704 E BOSTON ST		GILBERT	AZ	85295	85296	Outpatient Surgery Services	24	FACILITY OUTPATIENT	G0260	RT	0490	$2,000.00
164	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85024	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239		0490	$2,452.00
165	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85024	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380	33	0490	$2,787.00
166	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85032	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378		0490	$2,787.00
167	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85032	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$3,177.00
168	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85032	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$3,177.00
169	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85260	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43239	59	0490	$2,452.00
170	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85260	Outpatient Surgery Services	24	FACILITY OUTPATIENT	43249		0490	$2,457.00
171	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85260	Outpatient Surgery Services	24	FACILITY OUTPATIENT	G0105		0490	$2,787.00
172	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85262	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378		0490	$2,787.00
173	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85262	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380		0490	$2,787.00
174	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85345	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45385	33	0490	$3,177.00
175	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85377	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45380		0490	$2,787.00
176	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85032	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378		0490	$2,787.00
177	IN	1043239338	201729172	NORTH VALLEY ENDOSCOPY CENTER	15255 N 40TH ST BLDG 8		PHOENIX	AZ	85032	85032	Outpatient Surgery Services	24	FACILITY OUTPATIENT	45378		0490	$2,787.00
178	IN	1043678626	811399621	HAVEN OF SCOTTSDALE LLC	3293 N DRINKWATER BLVD		SCOTTSDALE	AZ	85251	85032	Skilled Nursing Facilities	31	FACILITY INPATIENT			0192	$0.00
179	IN	1043678626	811399621	HAVEN OF SCOTTSDALE LLC	3293 N DRINKWATER BLVD		SCOTTSDALE	AZ	85251	85032	Skilled Nursing Facilities	31	FACILITY INPATIENT			0194	$7,935.00
180	IN	1043678626	811399621	HAVEN OF SCOTTSDALE LLC	3293 N DRINKWATER BLVD		SCOTTSDALE	AZ	85251	85032	Skilled Nursing Facilities	31	FACILITY INPATIENT			0420	$743.62
181	IN	1043678626	811399621	HAVEN OF SCOTTSDALE LLC	3293 N DRINKWATER BLVD		SCOTTSDALE	AZ	85251	85032	Skilled Nursing Facilities	31	FACILITY INPATIENT			0424	$50.00
182	IN	1043678626	811399621	HAVEN OF SCOTTSDALE LLC	3293 N DRINKWATER BLVD		SCOTTSDALE	AZ	85251	85032	Skilled Nursing Facilities	31	FACILITY INPATIENT			0430	$468.81
183	IN	1043678626	811399621	HAVEN OF SCOTTSDALE LLC	3293 N DRINKWATER BLVD		SCOTTSDALE	AZ	85251	85032	Skilled Nursing Facilities	31	FACILITY INPATIENT			0434	$150.00
184	IN	1043678626	811399621	HAVEN OF SCOTTSDALE LLC	3293 N DRINKWATER BLVD		SCOTTSDALE	AZ	85251	85032	Skilled Nursing Facilities	31	FACILITY INPATIENT			0636	$160.91
185	IN	1043690845	473325492	UNION HILLS PAIN PARTNERS LLC	4727 E UNION HILLS DR # 300		PHOENIX	AZ	85050	85083	Outpatient Surgery Services	24	FACILITY OUTPATIENT	62321		0490	$3,080.00
186	IN	1043690845	473325492	UNION HILLS PAIN PARTNERS LLC	4727 E UNION HILLS DR # 300		PHOENIX	AZ	85050	85254	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64633	RT	0490	$4,950.00
187	IN	1043690845	473325492	UNION HILLS PAIN PARTNERS LLC	4727 E UNION HILLS DR # 300		PHOENIX	AZ	85050	85254	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64634	RT	0490	$4,950.00
188	IN	1043690845	473325492	UNION HILLS PAIN PARTNERS LLC	4727 E UNION HILLS DR # 300		PHOENIX	AZ	85050	85282	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64635	50	0490	$11,992.00
189	IN	1043690845	473325492	UNION HILLS PAIN PARTNERS LLC	4727 E UNION HILLS DR # 300		PHOENIX	AZ	85050	85282	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64635	LT	0490	$5,996.00
190	IN	1043690845	473325492	UNION HILLS PAIN PARTNERS LLC	4727 E UNION HILLS DR # 300		PHOENIX	AZ	85050	85282	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64635	RT	0490	$5,996.00
191	IN	1043690845	473325492	UNION HILLS PAIN PARTNERS LLC	4727 E UNION HILLS DR # 300		PHOENIX	AZ	85050	85282	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64636	50	0490	$11,992.00
192	IN	1043690845	473325492	UNION HILLS PAIN PARTNERS LLC	4727 E UNION HILLS DR # 300		PHOENIX	AZ	85050	85282	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64636	LT	0490	$5,996.00
193	IN	1043690845	473325492	UNION HILLS PAIN PARTNERS LLC	4727 E UNION HILLS DR # 300		PHOENIX	AZ	85050	85282	Outpatient Surgery Services	24	FACILITY OUTPATIENT	64636	RT	0490	$5,996.00
194	IN	1053358945	561398929	ATRIUM HEALTH MERCY	2001 VAIL AVE		CHARLOTTE	NC	28207	85234	Hospital	22	FACILITY OUTPATIENT			0250	$68.20
195	IN	1053358945	561398929	ATRIUM HEALTH MERCY	2001 VAIL AVE		CHARLOTTE	NC	28207	85234	Hospital	22	FACILITY OUTPATIENT	80305		0301	$186.25
196	IN	1053358945	561398929	ATRIUM HEALTH MERCY	2001 VAIL AVE		CHARLOTTE	NC	28207	85234	Hospital	22	FACILITY OUTPATIENT	81025		0307	$138.15
197	IN	1053358945	561398929	ATRIUM HEALTH MERCY	2001 VAIL AVE		CHARLOTTE	NC	28207	85234	Hospital	22	FACILITY OUTPATIENT	82075		0301	$47.45
198	IN	1053358945	561398929	ATRIUM HEALTH MERCY	2001 VAIL AVE		CHARLOTTE	NC	28207	85234	Hospital	22	FACILITY OUTPATIENT	99285		0450	$3,245.55
199	IN	1053358945	561398929	ATRIUM HEALTH MERCY	2001 VAIL AVE		CHARLOTTE	NC	28207	85234	Hospital	22	FACILITY OUTPATIENT	G0378		0762	$6,603.00
200	IN	1063923340	450233470	BANNER CASA GRANDE MEDICAL CENTER	1441 N 12TH ST		PHOENIX	AZ	85006	85544	Hospital	22	FACILITY OUTPATIENT	93798		0943	$1,500.00
201	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85021	Hospital	22	FACILITY OUTPATIENT	96365		0450	$200.00
202	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85021	Hospital	22	FACILITY OUTPATIENT	96375		0450	$261.00
203	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85021	Hospital	22	FACILITY OUTPATIENT	99282		0450	$358.00
204	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85021	Hospital	22	FACILITY OUTPATIENT	J1200		0636	$6.90
205	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85021	Hospital	22	FACILITY OUTPATIENT	J2405		0636	$6.40
206	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85021	Hospital	22	FACILITY OUTPATIENT	J2919		0636	$27.20
207	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85021	Hospital	22	FACILITY OUTPATIENT	J3490		0636	$7.50
208	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85021	Hospital	22	FACILITY OUTPATIENT	J7030		0636	$11.40
209	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT			0272	$479.00
210	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT			0370	$970.00
211	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT			0710	$685.00
212	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT	45380	59	0750	$1,100.00
213	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT	45385		0750	$1,100.00
214	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT	70486		0351	$816.00
215	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT	71046		0324	$181.00
216	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT	73502	RT	0320	$198.00
217	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT	88305		0312	$72.00
218	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT	88305	59	0312	$72.00
219	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT	J2003		0636	$20.00
220	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85541	Hospital	22	FACILITY OUTPATIENT	J2704		0636	$25.00
221	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85553	Hospital	22	FACILITY OUTPATIENT			0637	$15.20
222	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85553	Hospital	22	FACILITY OUTPATIENT	72114		0320	$405.00
223	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85553	Hospital	22	FACILITY OUTPATIENT	72170		0320	$159.00
224	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85553	Hospital	22	FACILITY OUTPATIENT	74018		0320	$145.00
225	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85553	Hospital	22	FACILITY OUTPATIENT	80048		0301	$61.00
226	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85553	Hospital	22	FACILITY OUTPATIENT	85027		0305	$58.00
227	IN	1063923340	450233470	BANNER PAYSON MEDICAL CENTER	807 S PONDEROSA ST		PAYSON	AZ	85541	85553	Hospital	22	FACILITY OUTPATIENT	96374		0450	$202.00

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Sep 1, 2025.